Drug Misuse and Dependence

Topic Overview

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This topic is about drug
misuse and dependence in adults. For information about drug use in teens or
children, see the topic
Teen Alcohol and Drug Use.

What are drug misuse and dependence?

Drug misuse is using drugs in a way that harms you or that leads you to harm
others. You can misuse illegal drugs, prescription drugs, or
over-the-counter drugs.

When you misuse
drugs, you are not always able to meet work, home, or school duties. You may be
late to work. You may use drugs in dangerous situations, such as when driving
or operating machines. Or drugs may cause problems in your
relationships.

Drug misuse can lead to drug dependence, where you
are
addicted to a drug. The drug controls your life. Any
of the following can happen:

You take more of the drug over longer periods
of time and need more of the drug to feel "high."

You try to quit using the drug, but you are not able to.

You continue to use the drug even though it harms your
relationships and causes you to develop physical problems.

If you
stop using the drug, you feel sick. This is known as
withdrawal.

Drug dependence is a disease. It's not a weakness or a
lack of willpower. It's your choice to begin using a drug. But as you use it
more, your brain begins to change. This change can lead to a craving to use the
drug, and this can influence how you act.

What are the signs of drug misuse and dependence?

Changes in sleeping or eating habits, less
attention to dressing and grooming, or less interest in sex.

Up-and-down moods, a mood or attitude that is getting worse, or not caring about
the future.

Sneaky behavior, lying, or stealing.

Poor family
relationships, or relationships that are getting worse.

New
problems at work or school, or problems with the law.

Having these signs doesn't always mean a person is using
drugs. The behavior could be because of work or school stress, or it could be a
sign of
depression or another medical problem. But behavior
changes like these are common in people who misuse drugs.

How are drug problems diagnosed?

Drug problems may
be diagnosed at a routine doctor visit or when you see your doctor for a health
or social problem linked to drug use, such as anxiety,
depression, or family conflict. If a partner or friend
thinks you have a drug problem, he or she may urge you to see your
doctor.

Your doctor will ask questions about your symptoms and
past health. He or she will do a physical exam and sometimes a mental
health assessment.

How are drug problems treated?

Treatment includes
medicine, therapy, and support groups.

The first step in treatment is to quit using drugs. You may need medical care to manage withdrawal symptoms when you first quit. Some people call this detoxification, or detox.

After you stop using drugs, you focus on staying drug-free. Most people receive
some type of therapy, such as group counseling. You also may need medicine to
help you stay drug-free.

When you have stopped using drugs, you
have taken the first step toward
recovery. To gain full recovery, you need to take
steps to improve other areas of your life, such as learning to deal with your
work, family, and living situation in healthy ways. This makes it easier to
stay drug-free.

What can you do if you or another person has a problem with drugs?

If you feel that you have a drug problem, get help. You can visit a
doctor or go to a self-help group. The earlier you get help, the easier your
recovery will be for you and your family.

Helping someone who has a
drug problem is hard. If you are
"covering" for the person, you need to stop. For
example, don't make excuses for the person when he or she misses work.

You may be able to help by talking to the person about what his or her
drug use does to you and others. Talk to the person in private, when he or she
isn't using drugs or alcohol and when you are both calm. If the person agrees
to get help, call for an appointment right away. Don't wait.

Cause

Most of the time,
drug misuse starts with casual use. People don't use drugs because they want to be
addicted. Drugs can make
you feel good for a while. They may make you feel energetic, self-confident,
and powerful. You may take a drug to reduce
stress or
anxiety or to help you forget a problem.

Drug use
changes your brain and how it works. If you continue to use drugs,
you may develop strong cravings for them, and it may get harder to say "no" to further use. At the same time, you may begin to lose interest in
activities you always enjoyed. This is because you may feel that they are not
as enjoyable as using drugs. You may then become dependent.

Not everyone who uses drugs misuses them or becomes dependent. Other
things that influence whether this happens include your
genes, family, friends, and life situations. For more information, see
What Happens and What Increases Your Risk.

Symptoms

When drug use,
misuse, and
dependence occur, you are more likely to have changes
in your behavior than to have physical symptoms.

Changes in behavior

Changes in sleeping or eating habits, less
attention to dressing and grooming, or less interest in sex.

Up-and-down moods, a mood or attitude that is getting worse, or not caring about
the future.

Anger toward others, or treating others
badly.

Sneaky behavior, lying, or stealing.

Poor family
relationships, or relationships that are getting worse.

New
problems at work or school, or problems with the law.

Not keeping
up with old friends and activities, and finding new friends and not wanting old
friends to meet them.

These signs don't always mean a person is using drugs.
The behavior could be because of work or school stress, or it could be a sign
of
depression or another medical problem. But behavior
changes like these are common in people who misuse drugs.

If you
think you or a loved one might have a drug problem, use this short quiz to
check your drug use:

Symptoms in older adults

Drug use problems in older adults may go unnoticed, since the signs may be similar to those of
aging. Older adults often take more medicines, such as sleep medicines and
painkillers, that can lead to dependence.

Symptoms of withdrawal

When you are dependent on a
drug and you stop using it, you may have physical symptoms known as
withdrawal. These symptoms differ for each drug. They can include feeling sick to your stomach,
vomiting, having belly pain, sweats, nervousness and shaking, and
seizures.

What Happens

You may not feel that using drugs is a
problem. Maybe you feel that you are a casual user because you use drugs only
now and then. You may feel that you can stop using drugs at any time.

But drug use quickly can become a habit, and for many people it may lead
to
a substance use problem and
addiction. You may begin to use drugs without thinking
about how drugs can harm you and those you care about.

How drugs affect your life

If you're
pregnant, drugs can pass into your uterus and
harm your baby.

Drug use also can lead to problems with
your partner, family, or friends. You and
your family may feel that you have turned against each other. You may be angry at
them, and they may be angry at you. You may do poorly at work or in school, or
you may even quit. You also can have legal problems, like being arrested for
driving while on drugs or for using or selling drugs.

What Increases Your Risk

Not everyone who uses a
drug develops a drug problem. Certain things make
a substance use problem and
dependence more likely. These are called risk factors.

Genetic and health risk factors

Genes. People with drug
problems often have a family history of drug use. Genes may influence whether you use drugs and whether
you move from drug use to drug misuse and dependence.

Gender. More men than women use drugs. But
the rate of misusing prescription drugs is similar in men and women.footnote 1

Your mental health. If
you have a mental health problem, such as
depression,
post-traumatic stress disorder (PTSD), or an
anxiety disorder, you are more likely to use drugs. Treating mental health problems makes drug use less likely. And if you're using
drugs, treating mental health problems makes
recovery more likely.

Social risk factors

Early use. The earlier you began to use
drugs, the more likely you are to misuse them or become dependent. This may be because early drug use changes the developing
brain.

How you use. If you smoke a drug or inject it into a vein, you are more
likely to become dependent. These methods give you a
fast and intense "high," but you lose the high quickly and then feel low. This
may make you use the drug more often.footnote 2

The drug you use and how strong the drug is. Some drugs, such as heroin and cocaine, are so strong that
dependence is possible no matter how you use them.

Environment. If you live in an area where
drugs are easy to get and where drug use is common, you are more likely to use drugs.

Family and friends. You are more likely to use drugs if your family members or friends use them.

Problems with others. You may be more
likely to use drugs when you are having problems in your family or with
friends.

Not having purpose or satisfaction in your life. If you have no activities that give you a sense of purpose,
you may be more likely to use drugs.

When to Call a Doctor

Call 911 or other emergency services right away if you or someone else:

Has
overdosed or has
withdrawal signs. Be sure to tell the emergency
workers that you are or someone else is using or trying to quit using drugs.
Overdose or withdrawal signs may include:

Watchful waiting

Watchful waiting is a
wait-and-see approach. If you get better on your own, you won't need treatment.
If you get worse, you and your doctor will decide what to do next.

Watchful waiting is not a good choice for drug misuse and dependence. If
you have a drug problem, or if you believe that your health or other areas of
your life are being affected by drugs, you need to take steps to stop using
drugs.

Exams and Tests

Drug
use and
dependence may be diagnosed during a routine doctor
visit or when you see your doctor for a health or other problem linked to drug
use, such as
anxiety,
depression, or family conflict. If your partner or a
friend suspects a drug problem, he or she may urge you to see your
doctor.

Testing to see if you have a drug problem

If you think you or a loved one might have a drug problem,
use this short quiz to check for drug use:

Your doctor will ask you questions about your symptoms and
past health and will do a
physical exam. If your doctor thinks you have a drug
problem, he or she may ask about
current and past drug use. He or she also may ask if it's okay to give you a test to check for drug use,
such as a urine or blood test.

Your doctor may ask to give you
tests to look for health problems related to drug use. These may include
tests for
hepatitis B,
hepatitis C, or
HIV.

If you and your doctor agree that
you have a drug problem, your doctor probably will refer you to a specialist in
drug use or dependence.

If you use
drugs and have a mental health problem, it's called a
dual diagnosis. If you
treat only one problem, treatment may not work well. When you treat both
problems, you have a better chance of a full
recovery and less chance of using drugs again.

Treatment

Treatment for
drug use or
dependence usually includes group therapy, one or more
types of
counseling, and drug education. A
12-step program is often part of treatment and
continues afterward as part of your
recovery.

Treatment doesn't just deal
with drugs. It helps you take control of your life so you don't have to depend on drugs. You'll learn
good reasons to quit drugs. Staying drug-free is a lifelong
process that takes commitment and effort.

Seeking treatment

You might start with your family doctor, or your doctor may recommend that you
enter a treatment facility. A friend could bring you to a self-help group, such
as Narcotics Anonymous, or you might walk into a clinic that deals with drug
use.

You may have a treatment team to help you. This team may include
a
psychologist or
psychiatrist,
counselors, doctors,
social workers, nurses, and a case manager. A case
manager helps plan and manage your treatment.

You may be asked
questions about your drug use, health problems, work, and living situation. Be
open and honest to get the best treatment possible. Your team may
write a plan, which includes your treatment goals and ways to reach
those goals. This helps you stay on track.

Detoxification

Your doctor may decide you need
medical care to manage withdrawal symptoms when you first quit using drugs. This is sometimes called detoxification, or detox.

People who are dependent on
drugs often have to go to a hospital or treatment facility. Detox usually is
done under the care of a doctor, because withdrawal can be
dangerous without medical care. A doctor may prescribe medicines to help with withdrawal symptoms.

Therapy

Treatment for a drug problem usually
involves one or more types of therapy.

In group therapy, you talk about your recovery with other
people who are trying to quit.

Couples or
family counseling can help you to stop using drugs,
stay drug-free, and improve your relationships with your partner and
family.

Treatment usually includes going to a support group, such
as going to Narcotics Anonymous (NA) meetings. Your family members might also
want to attend a support group such as Nar-Anon.

Medicines

You may take medicines to help you quit
or to help you overcome
withdrawal symptoms. Medicines often are used for
dependence on
opioid drugs like heroin or certain painkillers.
Medicines that can help you include methadone (such as Dolophine) or naltrexone (such as ReVia).

Treatment programs

Treatment programs can be
outpatient, inpatient, or residential. They offer similar therapies. Your
treatment team can help you decide which type of program is best for you.

In
outpatient treatment, you regularly go to a mental
health clinic, a counselor's office, a hospital clinic, or a local health department
for treatment.

In
inpatient treatment, you stay at a hospital and have
therapies during the day or evening. You
most likely will then go to outpatient therapy.

Residential treatment provides a place for you to live for 6 months or more while
you recover. You get therapy and 24-hour care.

Some treatment programs give rewards, called vouchers,
when you stay off drugs. The rewards may get bigger when you go for a long time
without drugs.

Many programs give regular drug tests while you go
through treatment. Knowing that you will be tested can make you more likely to
resist your cravings.

What to think about

People with drug problems
often have other problems. They may need other
treatments, or other resources may be available to help them with the drug
problem.

If you have a drug problem and a mental
health problem, you will need treatment for both problems. Doctors call this a
dual diagnosis.

Older adults also may have drug
problems because of misuse of prescription medicines such as painkillers or
sleeping pills.

Some people are
sent to drug treatment because of a court decision. This may happen if you have
a drug problem and you commit a crime. A court may require treatment and then
keep track of your progress. Treatment often is available in prison.

Medicines

Your doctor may prescribe medicine during
detoxification to ease
withdrawal symptoms or during treatment to help you
move away from
dependence. These medicines are mainly used for
dependence on
heroin or other
opioids.

Medicines that can help
include:

Buprenorphine, such as Subutex. Buprenorphine works by
targeting the same places in the brain that opioids do.

Methadone, such as Dolophine. It stops you from getting the quick "high" of opioid drugs.

Recovery

Recovery from
drug use or
dependence means finding a way to stay drug-free while
changing your attitudes and behaviors. In recovery, you work to restore
relationships with your family and friends and with people at your job or
school.

Connect with family and friends. They can
help you by encouraging positive steps. But you have to be honest about your problems.

Take part in recovery group activities. You may have used
drugs to make friends or be with a social group. Your counselor or doctor can
help you learn skills to make friends without using drugs.

Find a
sponsor, and work with this person. A sponsor is
someone who has been in recovery for a long time and helps you stay
drug-free.

Lapse and relapse

Stopping drug use is very hard.
It's normal to have setbacks, even years later. Very few people succeed the
first time they try. A lapse or
relapse is likely.

A lapse is the first time you use a drug
again after you have quit, or brief episodes of drug use later
on.

A relapse is not being able to stay drug-free over time. It can
occur if you have a series of lapses close together or a lapse that leads to
heavier drug use over a longer period. A relapse is most likely to happen a few
months after you have quit using drugs.

A lapse or relapse doesn't mean that you or your treatment has
failed. It may mean that you just slipped up. You also may need more treatment,
another type of treatment, or more time in support groups such as Narcotics
Anonymous.

It's smart to
plan for a relapse before it happens. Your doctor, family, and friends can
help you do this.

A healthy lifestyle

Part of recovery is finding
your way back to a healthy lifestyle.

Exercise and be active. This may give
you something to do instead of thinking about drugs, and it also can help
reduce stress.

Eat a balanced diet. This helps your body deal with tension and stress. Whole
grains, dairy products, fruits, vegetables, and protein are part of a balanced
diet.

Meditate. It helps you feel calm and can give you a clearer awareness about your life.

For Family and Friends

If someone you care about has had a drug problem, you know how hard it
can be. You know how living or dealing with someone who has a drug problem can
change and even destroy your life. But family members and friends can play an important role in helping a loved one recover from drug use and dependence.

Encourage treatment

No longer making excuses, such as
covering up for missed work or missed activities with children. Don't lie or
stretch the truth to help the person.

Finding a good time to talk
to the person. Say clearly how the person's drug use is harming you and that
you will take action if he or she doesn't seek help.

Being ready and able to help when a decision is
made to get treatment.

Help with treatment and recovery

After the choice for treatment
has been made:

Make sure the home contains no drugs or items
that help people use drugs.

Be involved and
patient. Attend recovery meetings with your loved one, and be supportive. Know
that it may take a long time for you to trust and forgive the person and for
the person to forgive himself or herself.

Be aware that your loved
one may seem like a different person after he or she is drug-free. You may need to build a new
relationship.

Understand that you have the right to know how
recovery is going, but you should ask about it in a respectful way.

Help your loved one plan for a relapse. Most people
relapse after treatment. This doesn't mean that the treatment failed. Try to help
your loved one see relapse as a chance to do better and keep working on skills
to avoid drug use.

Focus on the positive actions your loved one is
making.

Prepare for complex emotions

You
probably will feel relief and happiness when the person decides to get help.
But treatment and recovery mean changes in your life too. Your emotions may
become more complicated. You may:

Resent what the person did to you in the
past.

Not trust the person. You may not want to give the person the
house key, the car key, or money. You also may feel guilty about not trusting
the person.

Find it hard to give up or share your family role. For
example, if you took over raising your child or children when your partner was using drugs, you
may resent him or her becoming involved again.

Resent that the person is spending more time at meetings or
with others in recovery than with you.

Worry so much about relapse
that you avoid anything you feel may upset the person.

These feelings are common. You've been through a bad
period of your life, and what happened isn't easy to forget. Nor is it easy to
forgive the person. Keep in mind that recovery is the road to a better life
and that you can help your loved one get there.

Find your own
support. Nar-Anon and similar programs are for people with family members or
friends who have drug problems. They help you recover from the effects of being
around someone who had a drug use problem. You also may try
family therapy.

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